Friday, June 4, 2021

Place Sets the Mental Agenda

 

 How environment affects brain functioning and cultural meaning




“Change the environment, change the brain, change the behavior.” 

                             -- Fred H. Gage, - neuroscientist

 

 “Architectural spaces can inspire the imagination of its inhabitants.”

– Ricardo Legoretta, designer of the Ft. Worth Museum

 of Science and History, Annual Report (Oct 2009)

 Place as mental context

The human mind is highly situational.  Although we rarely think in any conscious way about the power of our physical surroundings, our subconscious mind is ultra-sensitive to them, and changes gears with the slightest change in location.   Human situational awareness and the factors that create thematic cognition are just beginning to be studied and appreciated.  Brain research is now becoming capable of telling us, through imaging, what these factors are and how they work. There are even indications that the qualities of place – lighting, sound, thermotics (heating and cooling), can inhibit or promote brain cell growth.  But this research is just starting to reveal how fine-tuned our brains are to respond to the places we find ourselves – from the neo-natal hospital unit at birth to the places we travel, sleep, eat, work, play, bond with others, heal from illness and injury, and finally die—most often, in the hospital setting of birth.  

 Place sets the mental agenda

Where we find ourselves at any given moment determines what we think about, and how we process that thought.  This process is driven by social surroundings (who we are with), the cultural imprint of place (meaning) along a behavioral range (action within place), and the potential and outcomes of what happens in various venues (expectations, preferred values, and decision making). 

Cultural studies can define and analyze these factors to explore the potentials of a variety of settings and their effects—from simple seating design to the layered complexity of theme parks.  All five senses, especially sight and sound, play a role in the setting’s physiological DNA and its ties to perception and meaning.  The role of place is a rich example of cultural software acting as an IIS--integrated information system--that accommodates and facilitates the many venues we all encounter in our everyday experience. 

These contexts richly influence how we feel at any given moment, and our brains are fine-tuned (though largely at a subconscious operating level) to our surroundings.  Most of our information comes from our highly developed visual sense, but it has been pointed out by perception experts that sound often outranks sight as the cueing system that cuts past our conscious and rational prefrontal awareness to connect with our more primal brain centers.  (In watching film, for example, the musical score sets the emotional tone of the screen image, not vice-versa.)

Understanding environment

Dozens of disciplines—from art history and archaeology to neuroscience and industrial psychology—study environments, from ancient sites to space station design.  But there is far more to these environments and their artifacts than their physical qualities and ingenuity.  In terms of the human mind and its prime output, culture, the core reason to study material culture is ultimately to understand how it works on our minds.  Besides its utility as props in daily life (shelter, workplace, tools, decoration), the most essential question is:

What role do these artifacts and landscapes play in human thinking and behavior across time and in space?  In other words, how do our creations affect us as we live with and within them? 

Thought experiment

As an example, try this simple thought experiment.  Think about a range of contexts: conference room, swimming pool, jet cabin, bedroom, car, classroom, theater box, stadium – all with their own sensory inputs, comfort levels, and stressors (the demands on the brain and sensory systems).  

As a mental shortcut, think of several chairs:  a throne, an armchair, an electric chair, a beach chaise, a church pew, a roller-coaster seat, a massage chair.  How do each of these mini-environments operate as “thinking boxes” – influencing the way we process, making us smarter, dumber, present- or future-oriented, more social, or more private?   Virtually superimpose your body onto these various mini-settings and you can feel the mental shift that follows instantly.  Shift the context, shift the mentality.  This principle comes as close to being a human universal as it gets. 

Where we are, in fact, seems to be essential to consciousness – which is why medical rescue teams will ask you where you are as an index to awareness.  Where you are, in fact is key to who you are at any given moment; following the Japanese proverb (quoted in the TV series Mad Men), “A man is whatever room he is in.”  Further measures of general intelligence are orientation to person, place, and time.

Neuroscience seeks to define place impact in order to discover just how essential human activities can be enhanced: these include learning, mood, social motivation, brain activity levels, productivity, stress, even memory.  Mall designers long ago realized that expanding the field of choices available was central to raising sales; as was making customers feel affluent by keying the room tone to spaciousness, glamour lighting, and muted crowd-noise levels.  Food plays a role by raising the sense of safety and gratification; so that food courts are actually a core feature of successful malls in raising the earnings per square foot.

Brain science

Cognitive science is bringing on the future of design.  Based on these research outcomes and their implications for “experience architecture”--the design of spaces to become the places of human activity--cultural analysis is on a quest for the cultural geography of the mind. This means looking at the built environment not just for its intended pragmatic uses, but for something more sophisticated--as the delivery mechanism for mental and neurological states that it often inadvertently creates and encourages. “Room tone” is a term that can be adapted to describe the mind-setting effect of our surroundings. Place, through room tone, works like a channel changer, by evoking different styles and moods along the dial – tied into different brain regions and functions.

The brain on place

Place dynamics as a way to understand culture and cultural values enlists the collated wisdom of cultural geography, material culture study, neuroarchitecture, and social history and psychology.  The overall question is to discover and define the cultural logic that follows from the spatial logic in any given venue. To do this, the challenge is to discern from the way that places are actually used (their function, which is not necessarily the way they are designed to be used) by a series of basic questions, answered from the point of view of the space user: (source: David Pesanelli Design)

1. What is this place ABOUT?  Basic cultural purpose based on themeatics:  holistic meaning, not at the level of discrete detail

2. How does this place make me feel?  (neurological) Security is Number One – Stimulation is Number Two

3. Who am I in this context? – How do I fit the context? Do I belong?

4. How does this place call on me to think and act?  Who else is here?  What’s at stake?” – (risks and opportunities)

Design as experience

In fact, the purpose of all places is to induce various behaviors for a range of purposes—expressing the full span of human experiences on earth.  Built environments are designed to evoke and manipulate our mindsets, through leveraging memory, themeatics (our collective ideas about other times and places on exhibit), shared cultural values, and social consilience (groupthink or the “wisdom of crowds”). 

Historically, built design is more or less effective at this purpose—but there are far more less-effective designs than effective ones, and we need to know how to become much better at what people need, want, and respond to. Urban sociologist William Whyte remarked, “It is difficult to design a space that will not attract people.  What is remarkable is how often this has been accomplished.”

The more we know about the power of place and what drives it, the better our “thinking boxes” can be designed to act on and assist thought, decision-making, and behavior.  This is one definition of liberating human potential--matching our surroundings to the way our brain works. And of course this has always been the mandate of the designer, if not always the achievement, in making places better at their intended goals. 

Novelist John Fowles described the novel itself as a “filmic form,” based on cutting, dialogue, and a series of settings envisioned as film sets.  Since film became a major artform, it is the rare novelist who does not imagine what he writes as taking place on a procession of sets.  In two dimensions, film combines many alternative realities into a single channel, as the theme park does in three dimensions.  This is the multiverse made possible by multi-channel mixed media.  As media innovations take up more and more of our stage settings, these must respond by becoming better and better at incorporating them.  This idea has become a central tenet of any design project.

 

Sunday, May 9, 2021

The Language of Ideas

“For the first time in human history, cultural evolution began to outpace biological evolution as instinct and emotion were counterbalanced by custom and thought.”

The Emergence of Man: The First Men (1973, p. 110)

Language as Idea

Understanding and producing speech is one ability.  No one is yet sure how this ability emerged in our evolution as social animals.  But it is essential to who we are. 

Knowing what is meant by spoken words in episodic context is a separate, further kind of compound talent that takes a lifetime to develop in the refined, sophisticated art of listening for meaning.  Language in itself, as anthropologist Monica Smith points out in Cities: The First 6000 Years (2019), is necessary to pose imaginary constructs about both our history and future.  These make up the symbolic architecture that embodies ideas and the authority those ideas exercise over our thinking.  Stonehenge is a memorial and possible astronomical calendar; China’s eloquent Great Wall is a symbol of empire, while Di Modica’s charging bull sculpture is the ubiquitous symbol of Wall Street.

Language is a necessary precondition for thinking. As anthropologists Sarel Eimerl and Irven DeVore write in The Primates, “Of all the advances made by man, the invention of a spoken language probably did the most to set him apart from every other kinds of animal. We actually think in words and, without them, the great mass of human thought processes could not exist.” (p. 183)

Image (right): An example of early writing, inscribed on a clay tablet 4000 years ago.  This is a letter from a customer to a seller complaining that the copper ingots he purchased were of poor quality.  

Social Capacity

But of course, language is our great social invention, not only a personal and private way of flexing and developing ideas.  Language allowed for intensely personal habitats like homes and publicly symbolic spaces like temples and stadia.  Architecture and interiors—even the simple frame pergola--are always above and beyond functional.  They extend our imaginative world into both past and future.  This imagination of place illuminates who we are, privately and publicly, and realizes our potential through the art of design.  But that design is inspired by words and their exchanges.   

Language and speech began the human social capacity for planning and anticipating, without which no large design or enterprise would have had a chance of being imagined, plotted, or transformed.  The early communal hunt is exemplary.  The ability to manipulate ideas, images, and concepts is at the root of all our thinking—especially in describing things yet to come, but that we wish for and can imagine as real (Disneyland is just one example. So is going to the moon and to Mars).  Language is tied to symbolism – it is spoken symbolism, while the written word can transcend time and space – in the form of shared imagination. 

The endless combinatorial power of words adapts speaking and listening to our infinite human potential for shaping and reshaping the past, present, and future.  And it does so instantly as spoken language, and indefinitely as written record.  The art of speech, in tandem with the invention of fire for technological progress, can be considered the first stronghold of mixed reality, as any sentence can represent both the real and the potential.  As well as posing conjectures as a reality contrary to fact: as in Lewis Carroll’s Alice's Adventures in Wonderland, when Alice muses “When I used to read fairy tales, I fancied that kind of thing never happened, and now here I am in the middle of one.”

Word Wiring

The human brain holds two main speech centers in the left hemisphere: one in the higher-order frontal lobes, the other close to the hearing center.  We are wired to learn language, but only up through the early teens, and not past age 13.  The development of the pharynx is the key structure that made human speech physiologically possible. And brain capacity—750 cubic centimeters, the baby-sized-brain-- appears to be the minimum requirement for the operational center. (The Primates, p. 109)  

While we cannot be sure when human speech actually took hold, we can begin with homo erectus from one to two million years ago as the stage when people could begin to communicate thought, not just emotion.  This goes beyond the emotion-based language of chimps.  Language thus set the bare stage for civilization.  A clue lies in static tool making as a marker of stalled language development for the Neanderthals, who disappeared 30,000 years ago from their last cave stronghold around Gibraltar.  Another clue comes from half a million years ago, when campsites became the meeting places that eventually extended to villages, towns, and cities.  Group life demanded coordination of ideas, not just action.  It was not until 6000 ago that full cities appeared, and now most of us live in them. 

The Idea Marketplace

The diversity inherent in urban life, as a site embracing multiple human groups, also engendered the art of trade—people, artifacts, ideas, and events—that makes every city a multi-layered experience, a port that draws in the region and the world.  The layered and combinatorial talents of language are indispensable to networking this much coordination and exchange within a single place.  Sumer was the birthplace of written language at the same time it became the home of the first larger cities. The reason is simple: the ancient world ran on trade, as does civilization as we know it, and Sumerians were well positioned as a trade hub with literacy and architecture.

The gift of language provides a magnificently efficient and versatile system of communication.  Its coded series of sounds conveys thought at least 10 times faster than any other method of signaling possibly can—faster than hand signs, moving pictures, or even other kinds of vocalization.  Language is man’s passport to a totally new level of social organization, the tool that allows him to vary his behavior to meet changing conditions instead of being limited by less flexible action patterns, as other primates are. (The Emergence of Man, p. 99)

As the first social stage of making imagination real (the first being inside our singular brains), speech allows us to step outside the self to see, name, and express things so that others can grasp them from our viewpoint and use that personal version to nourish and inspire their own thought and imagery. This was the first crossbreeding of ideas.  Ideas are also best implemented when they can be shared.  This mind-melding, knowledge transmitted through the flexible network of word play, is symbolic thinking indispensable to cultural evolution—running through millions on millions of language-based minds over eons. It created a feedback loop with the brain by which we not only communicate with spoken language (at about 120 words per minute) but think in it (along with images) at about 600 wpm as well. In terms of speed and thought trading, it is unequalled and unstoppable.

Increased linguistic competence led to growth and changes in the brain, which in turn led to the growing catalogue of cultural toolbars, concepts, and artifacts.  This process created the oversized brain that has gone on to create ever-larger inventions and devices.  As Terry Eagleton puts it in The Idea of Culture (2000), “What is peculiar about a symbol-making creature is that it is of its nature to transcend itself.” Language is the cognitive heritage that powers every artistic act, including architecture, literature, theater, music, the graphic arts, and beyond. “Human beings move at the conjuncture of the concrete and the universal, body and symbolic medium, but this is not a place where anyone can feel blissfully at home…Language helps to release us from the prison-house of our senses, at the same time as it damagingly abstracts us from them.” (p. 97)



Monday, April 12, 2021

The City and Urbanity

 

 
Remains of Hisham Palace in Jericho 


“A city is more than a place in space, it is a drama in time.”

 - Patrick Geddes, first urban planner, Cities in Evolution (1915)

 

In the year 1800, only 3% of the world population lived in cities.  Today there are 4,000 large cities worldwide. By 2030, it is predicted that 60% of us will live in cities—and some very large ones.  The 33 megacities, with 10 million or more, (UN, 2018), are growing, many in Asia.  The great majority of human beings, 75-85% of the populations of North America and Western Europe, now live in major cities and their metroplex extensions, as does half the world population.   Rome passed the one-million mark by the end of the first century BC, then declined when the Western Empire’s capital moved to Ravenna in 402 AD. 

By 1850 London became the first city after antiquity to attain a population of a million; fifty years later, in 1900, Greater London had 5 million people.

60,000 years ago, modern humans had populated Europe.  The Holocene period saw agriculture and domesticated animals—and the appearance of Jericho, an ongoing small walled settlement on the West Bank that dates to 9000 BC.   Around 5000 BC, people began to live together in formal groups with work and social roles in permanent settlements—like Athens in Greece, and Byblos in Lebanon.  In Serbia, Belgrade remains one of Europe’s oldest cities, with settlements back to the Neolithic in 7000 BC.  Plovdiv, Bulgaria is nearly as old, back to 6000 BC. Towns and cities began to form the beginnings of urbanity, predating the Bronze Age back to the Neolithic.

A social psychology of urbanity developed as the mindset that we now recognize as civilized thought and behavior.  The proximity principle – the propinquity effect that contributes to attraction between people--also requires moderation of behavior, voice and speech, manners, working and leisure behavior—like sports--and the management of complex networks of people, activities, and beliefs.  Religious affiliation is an example of a continuously self-reinforcing colleagueship that builds community and subcultures.  But group continuity is also a lightning rod for conflicts between groups.  Clashes between and among Christian, Moslem, and Jew, and between their many sects, date from their founding and are ongoing global forces.   

The practice of group living allowed specialized knowledge that led to the metamorphosis of small settlements into larger and larger groups, cities, and regional civilizations with lasting influence on human development.  As the historian Jacob Bronowski noted in The Ascent of Man, agriculture and the settled way of life engendered “a form of human harmony which was to bear fruit into the far future: the origin of the city.” In the Mesopotamian world of Turkey, Iraq, and Syria, the first networked urbanization occurred among city-states, leaving the largest set of ancient artifacts, the invention of writing, the wheel, the 60-based counting system, and large-scale agriculture.  In the Indus Valley developed water management and drainage, harvesting routines, and town planning.  Egypt produced the pyramids, astronomy for horticulture, and engineering.  On the Yucatan Peninsula, the Mayan world evolved astronomy and calendars, large-scale agriculture, and engraved stone architecture.  All these developments called for management science.  Cities are the curators of human knowledge and the care and feeding of that knowledge—the art and science of knowledge preservation and transmission.

The city is the original and ultimate mixed-media creation including augmented reality, arts and architecture, customs and etiquette, words and images, ancient craft and state-of-the- art technology, life and art.  Every city is a multi-layered reality that presents with novelty and dynamism on one hand, as well as established structural, infrastructural, and natural or peri-natural features on the other.  Trees, parks, hillsides, mountain, field, beach and ocean backdrops –these landscapes are there as staging, folded into the city’s design as ornamentation.  The city’s setting changes the way we look at nature as aesthetics, a kind of design operating ancillary to streets, monuments, buildings, open spaces, and the city profile, the skyline.  These are in constant flux.

Cities are complex permanent exhibits that, like museums and theme parks, invite us back by steadily updating their content and presentation.  Commercially, we see this everywhere, from supermarket shelves to the showcase windows of Tiffany’s and the bakery case at Starbucks.  The human pageantry—the population who live in and use the site--is the theatrical vitality that makes everything come alive as what Disney Imagineers call “streetmosphere,” the cityscape of human drama. Just by sheer numbers alone, the myriad factors that make up a city can be combined and recombined to recapitulate the history of the world and prefigure the future as a design for living.  Along with their human inhabitants, cities showcase diversity across many categories—as fashion, music, food, literature, the arts, industry, language, religion, and learning.  This diversity extended beyond the arts in the form of intermarriage between groups, mixing the gene pool and raising opportunities for new adaptations that hastened evolutionary advantage.  

10,000 years ago, agriculture as a revolutionary way of life for communities made cities possible, as did language, writing, money, science, and universal religion – forming the first shared cultural platform that would make living together possible.  The world’s oldest surviving city is, by a margin of millennia,  Damascus in Iraq, the first sizeable city of 2 million still standing (Jericho, which may be the first town, dating from 9000 BC, is a small settlement of 20,000 today).  Just as agriculture at a distance (the “hinterlands”) made the city possible, high and mobile tech have made of the megacity the smart and super-extended city-state, like Singapore or Dubai.  From their origins as protective fortresses that were adaptable as well as livable, cities have blossomed into the megastructures we know today that carry forward the cultural mandate to evolve our thinking and expression.

As cities began to proliferate, they promoted large-scale cooperation, density, and diversity, and role-identity versus just personality differences between citizens.  From 4000 BC the urban lifestyle has given us 6,000 years of living with the stressors of hierarchy, activity schedules matched to commerce, worship, sociability, industry and knowledge work, and seasonal events, sports culture, and the natural strain of strangers stressing each other out by constant needs to be mind-readers, wary and watchful about the behavior and motives of people with different agendas.  Unlike small Stone Age village life, cities mean daily contact with strangers, people who serve very contained work roles, and a 24-hour media presence —with whom we have no ongoing personal relationship but a steady psychological one. 

The urban way of life kicked off networking, social striving, and multiple associations, and constant change as an expected part of human existence, as well as placemaking, managerial and middle classes, and consumerism as the “urban species” lifestyle (Monica L. Smith, Cities: The First 6000 Years, 2019).  Smith calls cities “the first internet.”

Wednesday, March 24, 2021

Cultural Analysis: Revealing thinking, decision-making, and behavior


Human problems are rooted in culture.  That is, they are problems about values, community, and human factors like age, class, and gender—which are dimensions of culture.  Over the past two decades, I have developed several models and definitions that frame culture as the shared mind of human societies. This is reality we create by common consent. It is the set of clues that defines the largest system of meaning possible, one invented and growing along with our evolution as a species. It is still in development. And the mega-system all other human systems fit into.

Here are a few examples of how culture shapes decisions below our conscious threshold.   

Medical compliance:  A pharmaceutical company may develop an excellent medication that will save lives, but the way patients actually use it will determine how wide its acceptance and effectiveness will be. If a medication requires you to take a tablet every six hours, are you going to set your alarm clock to wake at 4:00 a.m. so you can take a pill? Anyone who has spent time in a hospital bed knows how annoying to is to be awakened by a nurse in the middle of the night because it is time to take your medications. Similarly, the long sticky Q-tip used to detect Covid-19 (nasopharyngeal or NP test) is the testing device that swabs inside the upper nose to detect the virus.  It is universally detested.  Even health-care workers, who must be tested weekly, dread this procedure.  It is invasive and psychologically difficult.

Why?  Because it goes very far up your nose, which is one of the body’s hot spots – along with the eyes, ears, mouth, breasts, and lower down, the buttocks and genitals.  This test invades a sacred body space: we just know intuitively that it feels wrong (OBGYN exams feel weird, too).  How many are not getting screened at all, for this reason alone?  Yale developed a saliva-only version that works as well while safer and noninvasive (August 2020).  It’s not yet available.  Next time, a study of how humans relate to their own bodies—the biology basis of culture—would reveal this problem to promote a far better solution. 

The work of cultural analysis is to crack complex issues and artifacts by getting at the (often invisible) human factors involved.  These tools often have to work around hidden cultural assumptions that prevent a thorough appreciation of social bonds such as gender, age-based change, and context.  They can reveal how these dimensions all work to drive thinking, behavior, and decision making. 

One example is race. The single Race category in current sciences is “Human.” Not a political statement, but a scientific one.   Race is a cultural construction, not one grounded in science.

Race versus Class:  When people talk about race, they are almost always talking about class. Race has often been used as a marker for class, but they are in no way comparable.  Labeling comes with a set of assumptions. If race is a negative label, that label can signal class-based assumptions like poverty, crime, failure, diminished status, or disruption of other classes’ agendas.  But Americans don’t really talk about class. Class is harder to define or measure than race, and in the US, we assume that no one is destined to be confined by the class they were born into. It is heavily mixed with ideas about achievement, social mobility, aspiration—as well as blame, when the first three aren’t attained.  Middle-class is the preferred state (even over upper class, at least when it comes to self-identification) and failure to arrive in the middle is often seen as the fault of the individual.  Which is why falling short is frequently assigned to lack of motivation, social ties, self-esteem, or social justice. 

The aim of cultural analysis is to make the invisible visible, to derive the core cultural values - the preferred states - that drive any culture as its engine of meaning. What are people driving at – what are they trying to achieve with their money, time, energy, and social connections?  The simplest and most accurate method is by studying group behavior. If what people say doesn’t match what they do, follow the behavior. Behavior is how we truly express belief.

Cultural analysis can identify and frame the cultural values equation active in any number of domains, from gender agendas and mall design to the high-stakes decisions of the middle class:  college, career, car, house, and spouse.  How does the short list of cultural values serve as the default to making these decisions?  Inherent in much of American decision-making are issues of class that even ad agencies refuse to address directly – especially as applied to higher education, the wellspring of class identity.

Higher Education:  As one case example, the college experience isn’t about libraries bursting with information, or even degreed professors (two ways college is sold).  College life is socialization--learning lifestyles and mentalities that allow following a sophisticated path forward into work and social channels that mark high-value futures.  These futures rely on relating to other college-educated people (world-wide) across professions and national borders.  This could be called global style. 

Global style:  Higher education underpins a world-class style loosely fashioned on British and American models, with English as the lingua franca, enabled by digital technology (computers, science, media), an enlightened secular outlook, and the primacy of the individual over the group (America’s prime directive).  Otherwise, this international style is diverse, gender-equal, and based on middle-class, pan-ethnic, and unapologetically future-oriented vistas. 

The cultural analysis approach interprets culture as the common language of social influence and aspiration. Like the language component of culture, it is shared code for understanding reality distinct from other codes, with its own structure and expression. 

Four Dimensions

Our model takes four major dimensions to be key study areas –gender, age, context, and community.  This approach considers gender as the only biological difference between people.  What is the first thing we notice about someone we’ve never met in person before?  The answer is gender.  Yet as many times as I’ve posed this simple question to people, they never think of male or female because this difference is just simply noted subconsciously.

Age stages from infancy through old age are not just biological; they determine decade by decade our priorities in making decisions.  Context—our social and physical environment—sets our mental agenda: what is this place, and what am I supposed to do, and who should I be, while I’m here?  Place is a total mental as well as psychological container.  Community is our social sphere of influence, including, working out of the life circle from the center, self, mother, father, siblings, relations, neighbors, associates (including religion), colleagues, familiars (your local supermarket checkout or postal worker) and finally, strangers (who we look at for signs of danger, and if we don’t see any, we ignore). 

The current clashes on culture, cancel culture, and political correctness are matters of class, not race.  Looked at in this way as cultural issues rather than political ones, they can be redefined, re-cast, and re-considered in terms that people can relate to.  It can be incredibly difficult to change people’s minds about race, and you can’t change someone’s race, either.  But class is fluid, changeable, and something people can do something about.

We explore the research bases of Popular Culture, American Studies, cross-cultural studies, decision theory, evolutionary psychology, and social science to show how cultural studies (taken without political bias) can be aimed to understand how people—as customers and clients – are influenced to think and act.

Sunday, February 28, 2021

Do you know your Medicare number offhand? Try memorizing this!

 

 


Being asked for a new piece of information by Reception when you are waiting in line for a colonoscopy screening is no fun – especially when this information is not listed anywhere as required for check-in, and you’ve never been asked for it before.  In my case, it put me in the role of problem-solver, not my job as patient.  Yet another example of assumptions made by medical centers but not communicated to the patient—especially in time to do anything about them. 

The latest Medicare number is an 11-digit alphanumeric randomly generated “Medicare Beneficiary Identifier” (MBI), introduced to prevent fraud and identity theft and protect patient information.  It went into effect in January 2020.  It replaces the familiar Social Security number.  Normally it is part of any insurance company record, whose own member number substitutes for the Medicare card.

Like Canada’s postal code (as well as the British, Irish, and Dutch), but even longer than the longest such postal code in the world, Iran’s 10-digit format, it is difficult to read, type, or memorize.  This is, of course, the better to thwart thieves intent on ID theft by making it impossible to guess, and by removing any links to Social Security.  But the same goes for the legitimate code owner: in this case, me.  Here’s the format:  1AA1A11AA11, where A is a letter and 1 is a digit. 

This might be expressed as 5DH7D32RS87, for instance (not my personal MBI, BTW).  This format risks mistaking certain letters for numbers (like O and l for zero and one), and the Q looks a lot like zero while G looks like a 6 and B can appear as 8.  When you type out these mixed codes, your brain is forced to toggle between two systems, numeric and alphabetic, which results in mental stress.  It also requires the added motion of hitting and releasing the Caps key again and again.

Recently I had a close encounter with this piece of information I didn’t know I needed, and unlike my SS number, have never tried to memorize.  I arrived at Reception at 8:30am for my screening, for which I had spent the past week prepping with diet and clearing-out medication—not a process anyone ever looks forward to repeating.  The screening itself is easy; the prep is where all the work is.  Just the thought of wasting and then repeating this effort is highly stressful.

Everything went fine until I was asked for my Medicare number.  I never carry my Medicare card, and I knew the clinic had all my insurance numbers from six months ago.  The patient instructions specify not bringing any valuables, so I left them home.  Here I was now thinking that all my diet and prep steps were about to be derailed – an upsetting potential.  According to the reception staff, Medicare is insisting more and more often on the number, and the practice must enter it in order to admit the patient.  Of course, had I known I needed it, I would have made a point to bring it with me.  Apparently there is no advance notice – just a demand by the check-in system that works by random chance.  And at a point when there is really nothing the patient can do about it. 

This missing code instantly created a gap that had to be bridged, one that threatened to block my care.   As the staff began running around trying to figure out this sudden new demand—as if this were the first time they had ever seen it--I began thinking hard: how could I as patient solve this for Jefferson GI?  And a tandem thought: Why was this suddenly the patient’s job?  This is analogous to standing in line to board your plane, only to be told you need a second form of ID—and all you have to show is your driver’s license.

I suggested calling Cigna, my Medicare Advantage insurance, which must link to Medicare.  There was also Medicare itself; had they tried here?  How about my primary care doctor, also in Jefferson’s system?  Maybe Billing would have this information.  It turns out, after 15 or more minutes and a steady line of patients building out behind me, that’s where the department found it.  I was at last admitted, but only after a hair-raising episode of fear, uncertainty, and doubt.  Patient Assistance even suggested that if these ideas failed, I could always call my husband at home and have him locate it for me in my home office.  However, he had just escorted me to the building and wouldn’t yet be there to wade through my medical files.  Now my household was getting involved, not a direction I wanted to go. (Those living alone are on their own here.)

I did point out to Patient Assistance that this Medicare card requirement was a bottleneck that needed to be handled.  Will they be able to solve this?  Isn’t the reception staff tired by now of trying out fixes?  Don’t they need a solution that works?  Or is the patient going to be the go-to party to solve problems that belong to the health system?  I’ll find out in another year, when my return visit will schedule. 

Update:  On emailing Billing, I received the following reply from the staff: 

The front desk is required to ask all patients that have Medicare Advantage plans for their original Medicare ID# [the MBI].  The system prompts them to ask.  I’ve sent an inquiry to the registration team at Jefferson to ask them why this is such an issue. It seems to have become an “ask” after we had a recent upgrade.  I will let you know what they tell me when they respond to me next week.

Is this new prompt built into the software upgrade?  Reception tells me they see it randomly, not routinely.  In any case, upgrades need to be examined for any new demands on the users on both sides of the counter.  And then coordinated with instructions to patients before, not after, the admission process.  This clearly was not carried out, meaning the patient could end up without service.  At the least, it produces some hard emotions and memories, and delayed service that cascades back down the waiting line.    

 

Tuesday, February 2, 2021

Mission + Vision: Just Do It

 


Mission and Vision started as two separate exercises by senior managers to identify what their business is doing and what it ultimately wants to achieve.  These two statements (along with the Value Proposition for the customer outcome) are often now combined to express both being and becoming.  The main idea is to create a clear focus for decisions and opportunities in the service of a clearly stated direction and purpose. 

Steve Jobs said this about his company’s motivational value: “If you are working on something exciting that you really care about, you don’t have to be pushed.  The vision pulls you.”   General Eisenhower said much the same thing decades before about the easiest way to get a string to move. "Pull the string and it will follow wherever you wish. Push it and it will go nowhere at all."

A consultant to the US Army asked what their mission statement was.  "We don’t have mission statements,” the officer in charge replied. “We have missions.”  Organizations like the military are social enterprises, with public-good goals that citizens generally understand from the outset.  Productivity consultant David Allen’s company name tells what he does and what he wants for his clients: “Getting Things Done.”  The Moonshot Factory, the skunk works of Alphabet, puts their mission this way:  The goal is to “create radical new technologies to solve some of the world’s hardest problems.”  The desired achievement?  “10x impact on the world’s most intractable problems, not just 10% improvement.” 

Mission / Vision has a double role.  It works both to clarify purpose within the company for making decisions and to know how those decisions align with the company’s direction. It informs the self-image of the brand idea or company core ideal.  For external purposes, a capsule statement like Nike’s 1988 “Just Do It” slogan inspires confidence in the brand and serves as a legend that carries the brand’s dedication to sportsmanship and health.  Inspiring achievement of greatness, it still doesn’t reveal exactly how Nike expects this to happen.  (The story goes that the phrase echoed convicted serial killer Gary Gilmore’s last words to his firing squad, “Let’s do it.”)

For another example, how about Microsoft’s revised mission of 2014 “To empower every person and organization on the planet to achieve more.”  The original 1992 Gates and Allen purpose as a corporation was to “put a computer on every desk and in every home.” Because as soon as there was a computer on every desk (and Starbucks table), the mission had to be expanded and updated.  The Fortune counterpart is “Making business better.”  These are sweeping mandates, like IBM’s signature “Think.”  Are they too broad?  “Making the world better” and “Making a difference” are laudable aims.  But how, why, and with what results, and for whom?

I have always been fond of the elevator pitch, a telegraphically cogent mission statement made famous by the TV Western series “Have Gun, Will Travel.”  That’s the message.  The business card adds some needed information:  the principal’s name and contact information: “Wire Paladin, San Francisco.”  However, this explains HOW Paladin operates, but not what he does, which is far more important.  He settles disputes, often complicated ones, as a talented negotiator with the gift of understanding the real issues behind his clients’ conflicts.  He is often, however, mistaken for a simple gunfighter or assassin.   

Further problems emerge when we dig deeper, for example, with Ed Catmull, co-founder of Pixar and President of Disney animation studios.  Here is what he said about Disney animation: “The real goal of what we’re doing is to have a positive impact on the world.”  Or the mission of the East-West Center (where I did my graduate work at the University of Hawaii): “The East-West Center promotes better relations and understanding among the people and nations of the US, Asia, and the Pacific through cooperative study, research, and dialogue [at plenty of conferences].”  What question does this beg?  It’s a lofty goal, but how will the results be measured, and will they tell you if you are succeeding in the long view or just operating year to year?  What is “positive impact,” and “better relations and understanding”?  These cases should be red-marked by any business school. 

The Starbucks mission gets closer to the “How” question in their mandate “To inspire and nurture the human spirit—one person, one cup, and one neighborhood at a time.”

Corporate consultants Bain & Co.’s website presents a view of mission and vision that very few businesses seem to have enacted (April 2, 2018, home site).  “Ensure objectives are measurable, approach is actionable, and the vision achievable.”  That directive seems to live far from the common practice of even the biggest and most successful companies in drawing up their missions and visions. What is missing is accountability. 

How about revising a couple of missions: TED Talks “To spread ideas.”  Adding “One expert talk at a time” tells how this happens.  American Express: “We work hard every day to make AmEx the world’s most respected service brand.”  This can be made more effective by just claiming the outcome as “World’s most respected service brand.”  It’s good that AmEx works hard—but we assumed that.  And now back to Nike: “Bring inspiration and innovation to every athlete in the world.  If you have a body, you are an athlete.”  Is this believable?  Or just a form of flattery?  How about “Inspiring innovation for the athlete in everyone.”  (You’re welcome.) 

Like the Army, perhaps business needs more missions and fewer statements.

Here is a mission statement I made up for Cultural Studies & Analysis, my think tank that studies culture: “Explore the universe of culture to discover how and why people around the world think, believe, and act, in order to benefit both business and education.”  How will I do this?  By making my Vision into an achievable objective: “Work on interesting projects, with interesting people, and go interesting places [both mental and geographical].”  Both statements can be measured by project numbers, industries studied, and problems framed in ways our clients had not seen before, with outcomes to clarify human motivation for problem solving, creativity, and innovation. 

Sunday, January 10, 2021

Black Swans: What you don’t know CAN hurt you


There may be a piece of information consumers need that they don’t know exists - or even suspect is out there.  Black Swans suddenly change the way you see and assess situations, the “leverage multiplier” needed to redefine problems, revealing new sources for solutions.

“The unspoken breakthrough dynamics of a negotiation….  Factors you didn’t know about and were not accounting for.…the leverage multiplier.”

-- Chris Voss, Never Split the Difference (2016)

Black Swan events have become infamous factors in the global culture now emerging, the wider culture we all inhabit.  The pandemic of the past year 2020 is a leading example.  But the term is not a new one.* Once people thought that all swans were white, as those were the only ones they had ever seen. Their worldview changed when the first black swan in nature was actually sighted in Western Australia by the Dutch explorer Willem de Vlamingh in 1697.  From that moment of discovery, the swan of a different color at once became a metaphor for newfound potential.   In 17th-century London the term was used to denote an unforeseeable event, one with wide and usually unintended consequences. 

While the cues and markers might be around and even visible, until there is a verified sighting – real proof of existence that people can agree on—there is no mental file folder that can allow the mind to consider and build on an idea.  An example is the current Covid world crisis that, while predicted in theory, was nevertheless not seen or prepared for. Impossible ideas are relegated to fantasy, making it impossible to operate within the realm of creativity and innovation as possibilities with real potential.  Other examples of “impossible” inventions?  1) the theme park and 2) Assisted Living, both thriving institutions of consumer entertainment and senior living.

Founder of the Black Swan Group Chris Voss navigates corporations through the complex problem-solving process of negotiation, the key skill in multi-party actions. Voss has assembled a manual of problem-solving approaches based on his background as an FBI hostage negotiator.  His experience models the tactical uses of emotional intelligence to avoid compromise, ending with a resolution in the client’s favor.  

It is easy to imagine developing training along the lines suggested in the Voss book outside the more left-brained Getting to Yes approach, aimed at discovering the Black Swans in the equation to fill in vital information either missing or disregarded.  The simple recognition of these factors can result in summary resolution of problems that so far have been stubbornly resistant to a mutually satisfying solution.   

Part of the success outcome, of course, depends on the wits and experience of the negotiator to spot that piece of information, or its space in a familiar pattern, that will signal how the original problem got its start and kept on rolling.  As well as how to untangle and reorganize which facts and events are vital in order to redefine the problem and multiply the leverage to win.  

On the consumer front, these could be: A glitch in computer programming no one has identified or fixed: the Y2K crisis, the widespread EPIC (“disaster”) software failures in healthcare, or the JPMorgan Chase bank overdraft charges of $34 up to three times per day. These each took many months to recognize and uncover.  Or a company acquisition that blocks customer repairs and refunds; an offer to reduce a loan rate has been retired, but thousands of customers are still eligible under its terms—and the new service reps don’t know it even existed.  Most typically, the company’s own needs, rules, and liabilities are driving the negotiation, but the service reps are talking as if they have a “customer-first” ethic, confusing every interaction.  The credit card company, the health insurance company, the hospital, the doctor, the physician practice group, and Medicare each have different policies and practices, and they are not in alignment, creating chaos for the patient and family.  No one has an aerial view of the overall gridlock—the EPIC program failures are still on a roll as of this month. 

Finding solutions requires relocating the problem connection between the customer’s problem and the company’s problem.  It takes a wider vista to find the missing piece or pattern. 

Taken to a panoramic scale, in a recent Fortune issue ((Aug/Sept 2020), editor Clifton Leaf writes about the value of cross-cultural commerce in itself. Cross-border trade now is nearly two-thirds of world economic output; long before this, it made America the first world superpower. This emerging world is opening new markets for ideas as the key attribute of the Global 500, the planet’s top firms.  “You get to dip into an entire new world of knowledge and innovation activity that has been closed to you before,” says Fabian Trottner, economist at UC San Diego who explores the export / innovation connection.  This wider horizon can yield unsuspected swans in the form of new information leading to new frames of reference.  Just what is called for to solve intractable problems ranging from consumer issues to international crises. 

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*The Black Swan: The Impact of the Highly Improbable (NY: Random House, 2007) by Nassim Nicholas Taleb is the popular source for this concept.